Florida Senate - 2010 SB 2184
By Senator Altman
1 A bill to be entitled
2 An act relating to renal disease; creating s.
3 627.64081, F.S.; providing legislative intent;
4 prohibiting an insurer that covers dialysis treatment
5 for patients who have end-stage renal disease from
6 requiring an insured to travel more than a certain
7 number of minutes to obtain dialysis treatment or from
8 requiring an insured to change to another dialysis
9 provider; prohibiting an insurer that provides
10 coverage for dialysis treatment from shifting the
11 responsibility for reimbursement in coverage type to
12 another payer; requiring such insurer to provide
13 written notice of any change in covered services,
14 network access, reimbursement, or patient liability
15 for dialysis or related services; prohibiting an
16 insurer from requiring prior authorization for
17 dialysis services more than a certain number of times
18 each year; providing that the Insurance Code applies
19 to violations of the act; providing that the act does
20 not apply to benefits provided under Medicaid and
21 other governmental programs; amending ss. 627.662 and
22 641.31, F.S.; providing that the provisions of the act
23 governing dialysis treatment for certain patients
24 apply to group health insurance, blanket health
25 insurance, franchise health insurance, and health
26 maintenance contracts; providing an effective date.
28 Be It Enacted by the Legislature of the State of Florida:
30 Section 1. Section 627.64081, Florida Statutes, is created
31 to read:
32 627.64081 Chronic renal disease.—
33 (1) Chronic renal disease is a life-threatening condition
34 requiring frequent and complex treatment. Access to dialysis
35 treatment is life sustaining and can prevent more expensive
36 complications and treatments. Due to the unique nature of
37 dialysis treatment and the limited responsibility of private
38 payers for these services, the Legislature intends that persons
39 who have chronic renal disease be provided protections under the
40 law to ensure access to the care that they need for survival.
41 (2) Any insurer that offers a health benefit plan that
42 provides coverage for dialysis treatment for patients suffering
43 from end-stage renal disease may not require, as a condition of
44 coverage or reimbursement, an insured to:
45 (a) Travel more than 30 minutes, under normal
46 circumstances, from the insured’s home in order to obtain the
47 needed dialysis treatment modality, or, if the nearest access to
48 the modality is located more than 30 minutes from the insured’s
49 home, to travel a greater distance than the distance to the
50 nearest location to obtain that dialysis treatment; or
51 (b) Change to another dialysis provider.
52 (3) During the maximum coordination-of-benefits period, any
53 insurer that offers a health benefit plan that provides coverage
54 for dialysis treatment for patients suffering from end-stage
55 renal disease:
56 1. May not take any action that could shift the primary
57 responsibility for reimbursement in coverage type from the
58 insurer to another payer, including, but not limited to,
59 Medicare, Medicaid, or any other governmental program.
60 2. Shall provide written notice to an existing insured
61 patient and to the provider of any change in covered services,
62 network access, reimbursement, or patient liability for dialysis
63 or related services by certified mail at least 12 months before
64 the effective date of such proposed change.
65 3. May not require prior authorization for dialysis
66 services more than twice a year. Such authorization shall, in
67 each instance, be inclusive of all necessary components of
68 clinical treatment as prescribed by the insured’s physician.
70 As used in this subsection, the term “coordination-of-benefits
71 period” means the length of time during which an employer
72 sponsored, union-sponsored, or any other health benefit plan is
73 the primary payer and Medicare is the secondary payer for health
74 coverage for a person who has end-stage renal disease and is
75 eligible for Medicare on the basis of the end-stage renal
77 (4) Chapter 624 applies to violations under this section.
78 (5) This section does not apply to benefits provided
79 through Medicaid or other governmental programs.
80 Section 2. Subsection (15) is added to section 627.662,
81 Florida Statutes, to read:
82 627.662 Other provisions applicable.—The following
83 provisions apply to group health insurance, blanket health
84 insurance, and franchise health insurance:
85 (15) Section 627.64081, relating to dialysis treatment for
86 insureds suffering from end-stage renal disease.
87 Section 3. Subsection (44) is added to section 641.31,
88 Florida Statutes, to read:
89 641.31 Health maintenance contracts.—
90 (44) A health maintenance contract that provides coverage
91 for dialysis treatment for patients suffering from end-stage
92 renal disease must comply with s. 627.64081, and the penalty
93 provisions of this chapter apply to this subsection.
94 Section 4. This act shall take effect October 1, 2010.